Hypertension and nephrology

[Hypertension and atrial fibrillation. Part 3. Screening of atrial fibrillation with active involvement of patients. New telemedicine devices]


FEBRUARY 20, 2019

Hypertension and nephrology - 2019;23(01)

DOI: https://doi.org/10.33668/hn.23.007

[In the early detection of atrial fibrillation, new devices and methods with smart phone applications for patients’ self-control a regaining increasing role. The author provides a detailed description of a number of reliable, validated - working on smart phones or without her solutions - equipment with pulse or ECG recording and the irvalue in every day clinical practice. They promote closer physician - patient cooperation and signal the future of prevention and care of atrial fibrillation. In the early detection of atrial fibrillation, new devices and methods with smart phone applications for patients’ self-control a regain in gin creasing role.]



Further articles in this publication

Hypertension and nephrology

[Letter to our Readers]


Hypertension and nephrology

[Statins for elderly people, in primary prevention?]


[In a recent, retrospective cohort study, statin usage in primary prevention was found being not beneficial for patients (i) without diabetes over 75 years of age, and (ii) with diabetes over 85 years of age (75-84 years total mortality of diabetics was also lower). These findings are in sharp contrast to the two outstanding, double-blind, placebo controlled, randomized, a primary prevention studies done with rosuvastatin. Of these, 50% reduction in LDL-C in JUPITER was associated with a 50% reduction in risk and 25% reduction in LDL-C in HOPE-3 with 25% reduction in risk. Furthermore, subgroup analyzes did not indicate lower efficacy for the elderly. The recommendation of the European Atherosclerosis Society for primary preventions of the elderlies recommending consideration of statin use in these cases (Class IIa) is particularly relevant, especially in the presence of other risk factors such as hypertension. In the primary prevention lipid treatment, we can see quite clearly till 75 years of age and hopefully, we will even further after learning about the results of STAREE, a study that is designed to elderly and in which 40 mg atorvastatin is applied.]

Hypertension and nephrology

[The importance of statin therapy in hypertension]

PARAGH György, PÁLL Dénes

[Hypertension and hypercholesterolaemia often co-occur and promote early cardiovascular disease. Previous studies have shown that antihypertensive treatment may be more effective if LDL cholesterol is also reduced. This may be due to the increased expression of angiotensin-1 receptor in hypercholesterolaemia, which increases peripheral vascular resistance through angiotensin-2, and adversely affects endothelial and smooth muscle cells. Other authors indicate that high cholesterol levels increase the production of angiotensin-2 through the activation of the chymase system. High cholesterol levels increase the amount of circulating oxidized LDL which binds to the transmembrane oxidized LDL receptor (LOX- 1) also activates the angiotensin-1 receptor. In addition, angiotensin-2 has an effect on intracellular cholesterol synthesis by enhancing the key enzyme of the synthesis of intracellular cholesterol, HMG-CoA reductase. The authors present the studies that support cholesterol lowering can contribute to lowering blood pressure and other major meta-analyses in which the beneficial effects of cholesterol lowering and lipid lowering on blood pressure reductions were not proven. In the background, it may well be that these studies are not designed to evaluate the effect of cholesterol-lowering drugs on hypertension in patients with hypercholesterolaemia, and non-statin-treated patients are not randomized.]

Hypertension and nephrology

[Sexual problems in CKD – a narrative review]

TÖRÖK Marietta, JÖRGEN Hegbrant, GIOVANNI Strippoli

[Sexual dysfunction is highly prevalent in patients with CKD, especially those receiving dialysis. Given the high prevalence of sexual problems in CKD patients, there has been growing interest in finding effective treatments for sexual dysfunction. PDE5i and zinc have been found promising interventions for treating sexual dysfunction in men with CKD in a systematic review of RCTs, but the evidence supporting their routine use in CKD patients is limited. In the Collaborative Depression and Sexual Dysfunction (CDS) Study, over a cohort of 1611 men in hemodialysis, 83% reported erectile dysfunction and 47% reported severe erectile dysfunction, with depression strongly correlated to this problem. Similarly, sexual dysfunction was highly prevalent in women undergoing hemodialysis. Of the 659 respondents, 555 (84%) reported sexual dysfunction and more than half of sexually active women reported sexual dysfunction, associated with age, depressive symptoms, menopause, low serum albumin, and diuretic therapy.]

Hypertension and nephrology

[Investigation of Diastolic Dysfunction and its Association with Complications in Hypertensive Patients ]

HATI Krisztina, POÓR Ferenc, VÁRALLYAY Zoltán

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[Hypertension and atrial fibrillation. Part 1. - Epidemiological data. The pathomechanism of PF in hypertension]


[Atrial fibrillation (PF) is the most common arrhythmia on the basis of analyzes conducted in different regions of the world. The main reason for this is the aging of the population. High blood pressure is one of the major factors of mortality in both developed and poor economical countries. The combined presence of the two diseases presents many hazards to our body. The most significant of these is the development of thromboembolic stroke, which is constantly increasing with age. The author analyzes in detail the aetiology called atrial cardiomyopathy, behind which there are complex structural, architectural, contractile and electro-physiological changes and leads to clinical manifestation of PF.]

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[The present and future of hypertension-care in Hungary]


[Hypertension is a population disorder of a kind that basically affects the health status, morbidity, mortality, quality of life of the population. The decrease complications its prevalence is favorably influenced by the correct treatment -defined by guidelines-, effective care, reaching and its sustained maintenance of target blood pressure, successful patient-physician co-operation. The importance of cooperation between the patient- physician- assistants- pharmacist is emphasized by numerous international organizations. The general quality of the health care system, the extensive use of the unified information system and the modern tools of telemedicine are increasingly important. The degree of drug adherence is also extremely important. According to our own experience, 40% of patients did not take the prescribed drugs in the second to third months of therapy. The Home Blood Pressure Measurement, Blood Pressure Monitoring as well as the patient education and drug revenue check mediated by smartphones, increase adherence. Real progress would mean that, like the care of heart failure, hypertension outpatients clinic (within the university centers, and the hospital departments of the county) would provide the therapeutic controll and care of the hypertensive patients.]

Clinical Neuroscience

[Efficacy of anticoagulation with vitamin K antagonists in acut stroke patients with atrial fibrillation - Hungarian results]

SAS Attila, CSONTOS Krisztina, LOVÁSZ Rita, VALIKOVICS Attila

[Background and objective - An estimated 20% of ischemic strokes are of cardiogenic origin, half of which is associated with atrial fibrillation (AF). Anticoagulation treatment of patients with this arrhythmia reduces their risk of stroke. Effectiveness and safety of oral anticoagulant therapy with vitamin K antagonists (VKA) is limited, however, by their well-known narrow therapeutic window and the substantial inter- and intraindividual variability of INR values depending on genetic and dietary factors as well as drug interactions. Our objective was to evaluate the prevalence of adequate anticoagulation and the level of anticoagulant effect actually achieved among patients with AF hospitalized for acute stroke. Methods - Patients with AF admitted to our hospital ward in 2012 for acute stroke (n=226) were included in the analysis. Using descriptive statistics, relevant clinical and therapeutic characteristics of the patients were assessed, with special reference to the INR values on admission (among patients with known AF), and the clinical outcomes. Results - Of the study cohort, 170 patients had a diagnosis of AF before the admission for stroke, but 47% of them did not take anticoagulants. Patients who suffered stroke while on anticoagulants (83 on VKA, 7 on low-molecular-weight heparins), were in most cases (75%) out of the therapeutic INR range, typically undertreated (INR<2). Overall, inadequate or completely absent anticoagulation was documented in 81% of the stroke cases occurring in patients with known AF. Of the entire study cohort, 41% was discharged home, 34% required continued institutional care, and 25% died. Conclusions - The inadequacy or lack of anticoagulation was observed in the vast majority of acute strokes in patients with known AF. These cases are often related to the well-documented limitations of VKA therapy in terms of its safety, tolerability and/or practical aspects. To prevent them, important changes are warranted in the anticoagulation practice, including the closer control of VKA therapy and the broader use of new oral anticoagulants.]

Clinical Neuroscience

[Effective, safe stroke prevention with novel oral anticoagulants in patients with atrial fibrillation. Focus on dabigatran]

SZAPÁRY László, FEHÉR Gergely, BOSNYÁK Edit, DELI Gabriella, CSÉCSEI Péter

[Non-valvular AF is the most common cardiac arrhytmia. Its incidence increases with age. AF is an independent risk factor for ischaemic stroke, representing a five times higher risk for it, associated with a high mortality rate. Beside AF, there are several other risk factors which influence the risk of stroke. Stroke risk calculator can be used to assess the risk of patient having a stroke. The most endangered group of patients with AF are those who have already suffered from cerebrovascular event. The only effective medication for prevention of stroke due to AF had been the application of vitamin K antagonists (VKA) which considerably decrease the rate of ischaemic event in a patient with AF providing that the INR is in the therapeutic range. VKA have several limitations of use in clinical practice and the fear of bleeding complications results an underusing of these drugs. Only 50% of all patients treated with VKA reaches the therapeutic range of INR. The breakthrough of prevention of stroke in recent years is undisputedly the coming out of novel oral anticoagulants (NOACs, thrombin and Xa-factor inhibitors). Recent studies suggest that these novel drugs prove the same efficacy as VKA drugs, furthermore dabigatran in a dose of 2×150 mg or apixaban in 2×5mg was statistically superior to warfarin in the prevention of stroke. NOACs have shown a large reduction in intracranial hemorrhage compared with warfarin. They are given as a fixed dose and do not require persistent monitoring making them much more convenient. NOACs at guidelines of European Society of Cardiology act as a preferable drugs in case of ischaemic stroke with AF. Probably the extended use of NOACs in clinical practice will be the mainstream of stroke prevention in the future.]